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One is a safety plan, in case her client feels emotionally unsafe at any point during the session. The other is a tech recovery plan, in case their virtual meeting is disrupted by a website crash, a server overload or slow WiFi.

That plan is new.

In the 21 days since she started working from home amid the coronavirus pandemic, O'Reilly has dealt with technology issues on about 70% of her telehealth calls, restarted about 25% of them and taken stretch breaks between each one. She starts each day with yoga and just purchased a pair of blue light-filtering glasses to help with eye strain from screen time.

It's taken some adjusting, and her new work environment is not without stress. It's isolating and at times overwhelming. Her client is having a similar experience. Normally, that would be considered a conflict of interest, but as the coronavirus sweeps the United States, confining most of the population at home, there aren't any other options.

Experts say periods of extreme stress or displacement such as natural disasters or wars typically coincide with an increase in violence against women and children. During this pandemic, victims are cut off from support and may be sheltering in place with people who are not safe. Survivors, too, may feel triggered.

Service providers like NOVA, along with domestic violence services and mental health agencies across the Northeast, are crucial, but with no in-person therapy sessions, social distancing in shelters and lost funding opportunities, they've had to get creative to ensure the most vulnerable members of our communities are safe now and in the months to come.

Preparation is a key to handling stress, but with new rules and restrictions evolving daily, many Americans were caught off guard when they were suddenly confined to their homes. It's a precariousness Wethington says most people haven't experienced before and don't know how to deal with.

"You find all kinds of things going on and all kinds of negative emotions building up even in households that typically manage anger and fear and anxiety fairly well," she said. "This is all building up."

There are healthy ways to cope with the feeling of losing control. Wethington suggests scheduling time to do something you enjoy, even sharing that time with a child or older adult who relies on you.

Nearly nine out of 10 incidents of family violence happen in the home of the victim or the home of a friend, relative or neighbor, according to the U.S. Department of Justice. A majority of spouse violence occurs in the victim’s home.

"When we talk about sheltering in place as a community, (which is) obviously done to keep everybody safe, that might feel very different for victims of domestic violence and children," said Heather Campbell, the executive director of the Advocacy Center in Tompkins County, New York.

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Reports of domestic violence in the United States could be much higher than statistics show, as victims can be afraid to speak out about their abuse.
Wochit

In the past week, the Advocacy Center's hotline operators have received fewer calls than usual. Campbell's spoken with other agency leaders across the state who've noticed a similar trend. Advocates suspect most people aren't calling because they're busy prioritizing basic needs such as food, housing and child care, but there may be others, Campbell says, for whom being at home means there simply isn't a safe time to call.

NOVA's executive director, Penny Ettinger, said she's also concerned about the lack of "external eyes" in schools, group homes or nursing home settings which can help expose abuse. And for survivors who are living safely, this new isolation and anxiety can trigger past fears and trauma.

"The inability to leave a situation is all too familiar for survivors," O'Reilly said. "Now they’re faced with that trigger all the time."

How domestic violence services are keeping connections

"These are some of our most vulnerable citizens that during this time of uncertainty and stress, they need us more so than ever," Rajotte said.

With the exception of emergency shelters, most domestic violence services are now housed online or over the phone.

Many counselors like O'Reilly are conducting video conference sessions with clients. Organizations' hotline phone numbers accept calls from anyone who's feeling isolated, has questions or just needs to chat.

While advocates are no longer being sent to hospital emergency rooms, they're still accessible by phone.

Orders of protection expiration dates have been temporarily lifted in New York, and other states have taken similar measures to ensure those protective measures can continue amid court closures.

Group sessions have been conducted over Zoom or on the phone and some national organizations have a live chat function on their website. Rajotte said a client has even reached out to Equinox through social media.

"It's very challenging," Bregman said. The services are more complex to provide, while the need is greater.

Ultimately, each organization is battling against an invisible wall, striving to let people in their communities know they're not alone.

"We’re here," Leahey said. "Our organization is open. We may not have a physical place for people to go but we are doing our best to help people feel connected."

Is a mental health crisis on the horizon?

In Tompkins County, Campbell estimates the Advocacy Center is losing at least $40,000 from lost fundraising events. NOVA's third-largest revenue source, a social enterprise thrift shop, is currently closed.

The calls that haven't been made, the abuse that's gone unreported, will still be there in the months to come, experts believe.

"When we get out on the other side of this," Rajotte said, "what are we going to see?"

Campbell is concerned about survivors who were "already living close to the economic edge" before the coronavirus hit the United States. Now they may be out of work, owing rent and unable to get another job. Where will they be when this is over?

Once people are able to easily leave their homes, Rajotte predicts more victims might feel compelled to leave their abuser, and need emergency or transitional housing.

For the general public, too, the pressures of isolation, unemployment or economic factors may spike a need for more mental health services.

"This is going to be a big mental health crisis," Wethington said. "It is already I think."

In an undisclosed location in Albany, Equinox's domestic violence emergency shelter is open.

Anyone who enters is asked whether they're experiencing any symptoms, whether they've recently traveled out of the country or be in contact with anyone who has. Meals are staggered to all residents to distance from each other. There's an isolation room in place in case someone needs to be quarantined.